Child & Family EBP Consortium Discussion Hour
Facilitated by Cricket Mitchell PhD

Promoting and sustaining implementation science
in challenging political environments

Motivated by experiences and concerns shared through the Child and Family Evidence Based Practice Consortium, this discussion hour provides opportunity to identify challenges and generate creative strategies to promote and sustain implementation science in challenging and sometimes adversarial political environments. We will discuss collaborative, strengths-based approaches to advance the field in times of decreasing resources and support for scientific inquiry and higher education.

Summary

Participants by country of residence: Canada (n=3); Scotland (n=3); USA (n=7)

Brief overview

• All participants were engaged and actively participated in the discussion. Some were frankly surprised that it wasn’t a presentation-style hour, but readily sat together around a large table and shared both their concerns and thoughts for addressing current challenges.

• One U.S. participant noted that although we are experiencing challenging political times, this is not new, it has existed for a long time; that said, current challenges are greater than before.

• Scottish participants noted that there is a positive shift in the U.K. toward using evidence to guide policy decisions; however, it is admittedly done with the goal of getting re-elected.

Concerns

• Changes in leadership or policy may shift funding from one agency to another; and, even if they have shared goals, there is a tendency not to share resources across agencies.

• Although the increased attention to implementation science over the past decade is exciting, historically there has been little funding for implementation science, and we are seeing existing resources decrease.

• As resources for applying implementation science decrease, agencies and organizations drift back to treatment as usual because it’s easier and cheaper.

• Meaningful efforts take time, and often it is difficult to work with a stakeholder group that is more concerned with immediate effects rather than long-term benefits.

• Keeping up with advances in technology is challenging; and the lag between science to practice leads to great harm, even death.

• Political decisions impact our most vulnerable and marginalized populations.

• There is a fatigue brought about by constant change and uncertainty, a fatigue which can be numbing and/or lead to apathy – how can we overcome this?

• We have a significant challenge in learning/understanding the best way to communicate our message.

Recommendations

• Current challenges may be good overall, because they are mobilizing many who were not actively engaged before – brings about unity and action.

• Co-creation, education, empowerment, and mobilization among those who need and receive the services we support.

• In the U.S. it is very difficult to ‘turn the ship’ at the federal level – mid-level bureaucrats are pushing things through; they are putting legislation where they want, bottom of the pile or top of the pile – a “ghost system” of the mid-level bureaucracy – these are who we need to target with our message.

• Another U.S. strategy is to focus efforts at the state level – a number of states are making innovative changes despite/regardless of federal policies or support – state-level policy is where we can make our biggest impact.

• The Nurse-Family Partnership model has done a good job getting conservative legislative support to secure stable funding (MIECHV) –we should look to this and other models that may have generalizable activities for sustainability.

• Build relationships among state legislators and funders – same players tend to shift around.

• Two lines of research are very relevant to us at this time – Trans-theoretical Model of Change and Motivational Interviewing – take a positive stance, match message to specific audience, target communication based on stage of the listener/politician.

• Rather than going directly to policy-makers, know who influences your policy makers and target your message accordingly.

• Understand the ‘personal rationale’ of your listeners; it will take time, but truly understand what drives them to do the work that they do, and tailor your message to match their personal motivations.

• What can we learn from sales/marketing/advertisers regarding how to influence behavior ? We must become better marketers.

• Match heartfelt stories with the data.